Diabetic retinopathy (DR) is the most common vascular complication in individuals with long-standing diabetes, with over 7.7 million Americans diagnosed. In the early stages of DR, pericyte loss, basement membrane thickening, and endothelial dysfunction involving loss of endothelial barrier integrity occur. Subsequently, both capillary- and neuro-degeneration result in severe vision defects.
Diabetes causes metabolic and physiologic abnormalities in the retina, and these changes suggest a role for inflammation in the development of DR. Using pharmacologic inhibitors or genetically modified animals, development of at least the early stages of DR, especially occlusion and degeneration of retinal capillaries, has been documented. It is becoming increasingly clear that neuronal cells of the retina also are affected by diabetes, resulting in dysfunction and even degeneration of some neuronal cells.
To date, current strategies for the therapeutic management of DR rely on symptomatic treatments with laser photocoagulation, intravitreal injection of triamcinolone and VEGF-neutralizing agents (e.g., Avastin®), with only partial success and untoward complications (e.g., hemorrhages). There is an enormous need for effective therapies to treat and prevent blindness in individuals suffering from DR, and to monitor the progression of the disease. As such, methods are provided for diagnosing, treating and monitoring DR.